椎体成形术与后凸成形术治疗老年陈旧性骨质疏松椎体压缩性骨折的相关问题探讨

目的:探讨椎体成形术(PVP)与后凸成形术(PKP)治疗老年陈旧性骨质疏松椎体压缩性骨折的疗效和安全性。方法:自2004年12月至2008年6月,采用PVP治疗28例(40椎)骨质疏松性椎体压缩性骨折,其中男11例(14椎),女17例(26椎);年龄70～91岁,平均72岁。骨折部位T5-L5。采用PKP治疗31例(43椎),男13例(18椎),女18例(25椎);年龄70～92岁,平均74岁;骨折部位T4-L5。术后采用疼痛视觉模拟评分(visualanaloguescale,VAS)、Oswestry功能评分、后凸Cobb角、椎体前中柱的平均高度及骨水泥的渗漏率等指标来评估两组疗效。结果:两组术后VAS评分和Oswestry功能评分都有明显下降,与术前相比有统计学差异(P0.01);两组间VAS评分和Oswestry功能评分降低值无统计学意义(P0.05)。两组后凸Cobb角及椎体前中柱的平均高度与术前比较差异无统计学意义(P0.05)。骨水泥渗漏率,PVP组3个椎体(7.5%),PKP组2个椎体(4.7%),但均无神经症状。两组比较差异无统计学意义(P0.05)。结论:PVP和PKP均能有效缓解老年陈旧性骨质疏松性椎体压缩性骨折所引起的疼痛,改善患者的脊柱功能,并且是一种安全有效的治疗方法。

Assessment of percutaneous vertebroplasty and percutaneous kyphoplasty for treatment of senile osteoporotic vertebral compression fractures

Objective: To investigate the clinical effects and safety of vertebroplasty and kyphoplasty for the senile osteoporotic vertebral compression fractures. Methods: From December 2004 to June 2008,28 patients (40 vertebrae) with osteoporotic vertebral compression fractures were treated with percutaneous vertebroplasty (PVP group),there were 11 males (14 vertebrae) and 17 females (26 vertebrae),with an average age of 72 years (ranged,70 to 91 years). The fracture site of vertebral body was from T₅ to L₅. Other 31 patients (43 vertebrae) were treated with percutaneous kyphoplasty (PKP group),there were 13 males (18 vertebrae) and 18 females (25 vertebrae),with an average age of 74 years (ranged,70 to 92 years). The fracture site of vertebral body was from T₄ to L₅. Theapeutic effects of all the patients were observed after operation,the item included visual analog scale (VAS),Oswestry score,Cobb angle,the height of anterior and middle column vertebra,and the incidence of cement leakage. Results: There was significant decrease in VAS score and Oswestry score after operation in both groups,there was significant difference between preoperative and postoperative(P<0.01). There was no significant difference in VAS score and Oswestry score between two groups(P>0.05). There was no significant difference in Cobb angles and the height of anterior and middle column vertebra between two groups before and after operation(P>0.05). Among them,there were 3 vertebrae cement leakage in PVP group(7.5%) and 2 in PKP group(4.7%),but no clinical sympton occurred. There was no significant difference in the incidence of cement leakage between two groups(P>0.05). Conclusion: Vertebroplasty and kyphoplasty are safe and effective methods in treating senile osteoporotic vertebral compression fractures,which can restore the height of fractured vertebra,relieve pain and improve function as well as minimize the incidence of cement leakage.